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Filing Complaints in California
Internal Complaints with Kaiser Permanente
All health plans are required to have an internal process for health plan members to file complaints and receive a response within 30 days. Call Kaiser’s “Member Services Department” at 1-800-464-4000 to file a complaint. You can also contact Member Services and file a complaint though your member account on kaiserpermanente.org or by visiting healthy.kaiserpermanente.org/support (follow the steps to select your region and then scroll down to the bottom to click on “File a complaint”).
If your health plan’s response to your internal complaint does not resolve your concerns, you can bring them to the healthcare consumer protection agency that oversees your type of health plan. (If there’s an urgent health risk, you don’t need to wait 30 days. You can contact the regulatory agency immediately.)
- HMO Members (and some PPO members): Contact the California Department of Managed Health Care (DMHC) by phone at 1-888-466-2219 or visit the department’s website to file a complaint. From the DMHC’s website: “If your health plan denies, changes, or delays your request for medical services, denies payment for emergency treatment or refuses to cover experimental or investigational treatment for a serious medical condition, you can apply for an Independent Medical Review (IMR). … You can also file a Consumer Complaint when you have other issues with your health plan. These issues can consist of billing problems, cancellation of coverage, claim and copay disputes, delays in getting an appointment, referral or authorization, access to translation services, finding an in-network doctor, hospital, or specialist, complaints about a doctor or plan and continuity of care.”
- Medi-Cal Managed Care Members: see #1 above for instructions for filing a complaint with the DMHC.
- PPO or High Deductible Plan Members: Contact the California Department of Insurance by visiting its website or calling 1-800-927-4357.
- Medicare Beneficiaries: Call the Health Insurance Counseling & Advocacy Program (HICAP) which is run through the California Department on Aging at 1-800-434-0222. Also see cahealthadvocates.org/hicap/. You can also contact the Medicare Rights Center National Helpline online at www.medicarerights.org/programs/national-helpline or call 1-800-333-4114
CalPERS Members: In addition to filing a complaint with Kaiser member services and either the DMHC or Medicare, CalPERS members can immediately file a complaint with CalPERs. (You do not have to wait until the conclusion of the internal complaint process with Kaiser member services.)